I lost my MaineCare coverage, and it might make me sick

By Heather DenkmireBangor (Maine) Daily News, Feb. 4, 2015

Imagine this. You make an appointment with a doctor. You arrive, show your insurance card, and take a seat in the waiting area. You have your appointment. You leave. You pay nothing. You never receive a bill from an insurance company. You never have to call the doctor’s office or the insurance company — and wait on hold endlessly — to straighten out billing or reimbursement paperwork errors. You simply go to your doctor and receive medical care.

Now, also imagine that you pay no monthly premiums at all for health insurance. There are no deductibles. There are no co-pays. You choose your doctor. There are no “out of network” issues to consider. And, best of all, the insurance company won’t deny coverage, refuse to pay, and stick you with the bill.

For the last three years, I have used a version of “single payer health care” called MaineCare. Sure, there were a few bumps in the road. Some specialists had very limited hours available for MaineCare patients. A couple receptionists turned visibly cold, downright rude in one case, immediately after learning that I was a MaineCare patient. And, MaineCare did insist that I try less expensive alternatives before agreeing to pay for an absurdly expensive medication — $1,500 a month! — to treat my psoriasis.

Other than those minor inconveniences, how I paid for my health care hasn’t been a concern. I haven’t had to worry about finding the money for co-payments. I haven’t had to spend hundreds or thousands of dollars to meet a deductible. My health care was simply paid for with government funds. Those funds come from taxes, including those I have paid for the last 30 years.

About six months ago, I received a letter from DHHS informing me that I was being put onto “transitional MaineCare.” This meant my income would need to be verified more frequently to determine my continued eligibility. I immediately thought about how what was now a paperwork hassle would have been a devastating challenge just a few years ago when things were really tough personally and financially. On Jan. 10, I received a letter indicating my MaineCare coverage would end Jan. 31.

It’s been scary. I’ll admit I put off going to healthcare.gov to find health insurance because I didn’t want to face the fact that I will now have a dramatic increase in my monthly expenses. Suddenly I have monthly premiums. I will have to pay for doctor visits. I will have to pay for about 60 percent of much of my care until I meet my new plan’s deductible.

It’s true that the Affordable Care Act has made the costs lower than before. But there is nothing low about going from paying nothing to paying about $200 a month just for insurance. Remember my $1,500-a-month medication? No matter how much the new insurance covers, you can be sure I’ll have to spend up to my new insurance’s $1,500 maximum annual out-of-pocket amount. That’s $200 a month, co-pays, co-insurance until I meet the $500 deductible, and likely up to $1,500 because of the expensive medication. From $0 to $3,900 or more for one year.

The worry about new expenses could very well impact my overall health. Fear of costs — even reduced costs at a place like Community Dental (which, full disclosure, is a client of my grant writing business) — kept me from going to the dentist for over a year. I am sure the same thing will happen, as I know it does for other people, when it comes to easily treated minor health issues. Even $20 here and $10 there add up quickly when my bank balances are terribly low.

The frightening truth is the costs of paying for health insurance and health care now put me at risk of going back into serious financial crisis. The costs of another crisis would be exponential, negatively impacting my children, my work, my personal life, and my health.

A 7 percent increase in payroll taxes for businesses — with zero dollars paid to any health insurance company — and a 2 percent increase in personal income taxes — with zero premiums, co-pays, or co-insurance — is a price worth paying for ensuring everyone has access to high-quality healthcare. That’s what the Economic Policy Institute estimates it would take to pay for truly universal health coverage.

Again, imagine it. You visit your doctor without paying anything and without dealing with insurance companies at all. That is “single payer” health care.

For those of you who think a publicly financed universal health care means more bureaucracy, significantly higher taxes, or government control of your health care, I dare you to read the FAQ on the Physicians for a National Health Program website: http://www.pnhp.org/facts/single-payer-faq.

Heather Denkmire is a writer and artist who lives in Portland with her two young daughters. After a few challenging years, she is growing her small business, where her team helps nonprofit organizations win grants. She can be reached at column@grantwinners.net. Her columns appear monthly.